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Increasing HIV testing of emergency department patients with increased risk for HIV and their partners and peers through provision of home HIVST kits and linkage to internet-based recruitment for HIV testing

In 2016, a pilot randomised study was conducted in an urban emergency department (ED) in Baltimore where an HIV screening programme operated. Patients who accepted ED testing and were identified as having increased risk for HIV were enrolled. Patients who consented were randomised to the HIVST group (i.e. received an oral fluid HIVST, or control group, i.e. received a pamphlet regarding the importance of regular HIV testing). Participants in the HIVST group were encouraged to report self-testing results using an established online HIV/STI screening website, 'IWantTheKit' (IWTK). Enrollees in the HIVST group also received 5 referral cards for their partners/peers to request HIV self-testing kit from IWTK. Phone follow-up was conducted at 1 and 3 months. Increase in HIV testing proportion was estimated as a rate ratio (RR) using a chi-square test.

Summary of findings

100 patients were enrolled and randomised. At 3-month follow-up, 20 (40%) patients in the HIVST group reported testing for HIV vs. 7 (14%) in the control group [RR: 2.9 (95% CI: 1.3, 6.1) or 3.2 (1.6, 6.6) excluding 30 patients lost to follow-up]. 95% of patients in the HIVST group who reported testing for HIV used the provided kit. 9/19 (47%) patients who self-tested at home reported their results to IWantTheKit, an online HIV/STU screening tool. None reported a reactive result for HIV. 54% of enrollees in the HIVST group reported that they distributed referral cards to their partners/peers; six used the referral card to request HIV and/or STI testing kits.